Delayed cutaneous hypersensitivity response in patients receiving nutritional support.

The sensitivity and specificity of skin-test antigens were assessed, and the prevalence of anergy was determined in a group of hospitalized patients receiving aggressive nutritional therapy. All patients referred to a nutritional support service during a nine-month period were assessed for intact cellular immunity using Candida albicans, mumps, streptokinase/streptodornase, and tetanus toxoid skin tests for delayed cutaneous hypersensitivity. Some patients were retested at two-week intervals while they were receiving nutritional support. A total of 195 patients (97 men) ranging from 15 to 92 years old were tested; 68 patients received repeat skin tests. Of the 195 patients, 181 (92.8%) reacted positively to one or more antigens when tested initially; all patients (including anergic ones) who were retested reacted positively. Candida and mumps tests produced the highest percentages of positive responses (80 and 75%, respectively); the use of these two antigens concurrently produced a 92.3% response rate. Nonresponding patients to a nonresponding antigen converted to responders to that antigen upon second testing more frequently than responders converted to nonresponders. Candida and mumps skin tests detected anergy and demonstrated that immune responses were maintained and often restored by aggressive nutritional support.